Medical studies reveal that some common medications may not be the best choice for older adults, due to declining benefits or increased risks with age.
Despite updated medical guidelines and warnings against the use of some of these drugs, changing treatment practices often takes years, and drugs with limited benefit or high risks may continue to be used.
Dr. Michael Steinman, a geriatrician at the University of California, San Francisco, attributes this in part to the time it takes for scientific findings to reach doctors, as well as the fact that doctors and patients become accustomed to certain treatment methods that, over time, turn into established habits, while the search for alternative treatments may be more difficult.
Recent studies on three drugs or drug classes common among the elderly in the United States highlight this problem.
Doctors have been warning for more than 20 years about the dangers of benzodiazepines, drugs used to treat anxiety and insomnia, including Valium, Xanax, and Ativan, as well as sleep medications known as Z-drugs.
Dr. Mark Olofson, a psychiatrist and epidemiologist at Columbia University, says these medications can impair balance, motor coordination, and cognitive abilities, increasing the risk of falls, fractures, and car accidents. They may also increase the risk of overdose in those taking them with opioid painkillers, and long-term use can lead to dependence and withdrawal symptoms upon cessation.
However, a study published in the Annals of Internal Medicine showed that the percentage of elderly people prescribed these drugs decreased from about 14% in 2015 to 11.5% in 2024.
But the decline halted in 2020, while the prescription rate among those over 75 years old rose from 12% to nearly 13% in four years. Prescriptions in long-term care facilities also doubled, and about a third of users were taking it for more than six months.
Olfson warns against abruptly stopping these medications, noting the need to gradually reduce the dose under medical supervision.
Diverticulitis, an inflammation of small pouches that form in the colon wall, is another example of treatment persisting despite changing medical evidence. While antibiotics were once the standard treatment, the American Gastroenterological Association recommended in 2015 against their routine use in uncomplicated cases, which constitute the vast majority of cases.
Clinical trials have shown that antibiotics offer little benefit in reducing mortality, the need for surgery, complications, or recurrence of infection in these cases.
However, a study of nearly 70,000 visits to 120 VA facilities found that antibiotics were prescribed in 97% of visits, despite changes in guidelines. Patients were just as likely to improve with a few days of paracetamol and a clear liquid diet.
Jesse Sutton, a pharmacist and researcher at the Veterans Affairs Health Care System, warns of the side effects of antibiotics, including nausea, vomiting, and diarrhea, as well as an increased risk of Clostridium difficile infection and the problem of antibiotic resistance.
Over-prescribing of these drugs remains common in other cases, such as some asymptomatic urinary tract infections and upper respiratory tract infections that are usually viral.
Aspirin differs from other medications in that it is easily obtainable without a prescription, which leads millions of elderly people to take it, believing that it protects the heart.
Medical evidence confirms the benefit of low doses of aspirin in what is known as "secondary prevention," that is, in people who have previously had a heart attack, stroke, or undergone certain cardiac procedures.
However, in "primary prevention," that is, for those who have not had these conditions before, the recommendations have changed. In 2019, the American College of Cardiology and the American Heart Association recommended against the use of aspirin for this purpose in those aged 70 and older, while the U.S. Preventive Services Task Force recommended against its use starting at age 60.
Extensive studies have shown that the benefit of aspirin for primary prevention is limited, while its use is associated with an increased risk of bleeding, particularly intestinal bleeding, and may also cause bleeding in the brain in rare cases.
Despite a decline in the use of aspirin for primary prevention between 2011 and 2023, more than a third of people aged 70 or older still take it.
Dr. Timothy Anderson, an internist at the University of Pittsburgh, points out that some older adults with high risk factors for heart disease may benefit from aspirin, making the decision to continue or stop taking it dependent on each patient's condition.
Anderson advises older adults who take aspirin to discuss the matter with their primary care physician.
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